Spontaneous Abortion
Gracy C. Espino
Definition
• is the expulsion of the fetus and other
products of conception from the
uterus before the fetus is viable.
• The loss of a fetus
during pregnancy
due to natural cause.
• A viable fetus
- a fetus more than 20 to 24 weeks of
gestation or one that weighs at least
500g.
- A fetus born after this point is
considered preterm or immature birth.
- before 20 wks - abortus
Development at 20 Weeks
Causes (Fetal)
- Developmental anomalies
- Chromosomal abnormalities
Causes (Maternal Factors)
a. Maternal age (above 35 y/o)
b. Structural abnormalities of
reproductive tract (congenital
uterine defects, cervical
incompetence)
Causes (Maternal Factors)
c. Inadequate progesterone
production
d. Maternal infections (rubella,
cytomegalovirus, poliomyelitis)
Causes (Maternal Factors)
e. Chronic & systemic maternal
disease(Uncontrolled DM, severe
HPN, untreated thyroid disease,
SLE)
f. Exogenous factors (tobacco, alcohol,
cocaine, high dose of caffeine,
radiation)
Causes (Maternal Factors)
g. Trauma
• Direct injury to the pregnant uterus by
penetrating wounds or by the steering
wheel of a car in a road traffic accident.
• A blow or a fall possibly as a result of
physical abuse.
Causes (Maternal Factors)
g. Trauma
• Indirect injury, such as surgical trauma may
occur by removal of an ovary containing
corpus luteum of pregnancy or during an
appendectomy.
• An electric shock of high voltage.
Pathophysiology
The fetal or placental defect or the maternal
condition results in the disruption of blood
flow, containing oxygen and nutrients, to the
developing fetus. The fetus is compromised
followed by hemorrhage in the uterine lining.
Necrosis and inflammation appear in the
region of implantation.
Pathophysiology
The detached conceptus, in effect, a foreign
body in the uterus which causes strong
contractions. subsequently expelled from the
uterus. Uterine contractions and dilatation of
the cervix result in the expulsion of the
products of conceptio.
Types of Spontaneous Abortion
1. Threatened Abortion
- possible loss of
the product of
conception
Signs and symptoms
- light vaginal bleeding
- None to mild uterine cramping
• Vaginal examination at this stage usually
reveals a closed cervix.
Management
• Ask LMP as management for pregnancy
bleeding will vary according to the age of
gestation
• Do not perform IE
• Instruct client to save all pads for
examination
• Tocolytics - to halt or prevent the start of
labor. (Ritodrine, Terbutaline, MgSulphate,
•
Isoxsuprine).
Management
• Ask for presence of clots
• Assess for abdominal pain
• Instruct client to have bed rest until 3 days
after bleeding has stopped
• Avoid coitus up to 2 weeks after bleeding
stopped
• Provide reassurance/be honest
2. Inevitable or Imminent Abortion
• loss of products of
conception that
cannot be prevented
Signs and symptoms
- moderate to profuse bleeding
- moderate to severe uterine cramping
- open cervix or dilatation of cervix
- rupture of membranes
- no tissue has passed yet
Management
•
•
•
•
Hospitalization
D&C
Oxytocin after D & C
Sympathetic understanding and emotional
support
3. Complete Abortion
• spontaneous expulsion of the
products of conception after the fetus has
died in utero
• S/S:
•
- vaginal bleeding
•
- abdominal pain
•
- passage of tissue
Signs and symptoms
On examination
• Light bleeding or some blood in the
vaginal vault
• No tenderness in the cervix, uterus or
abdomen
• None to mild uterine cramping
• Closed cervix
• Empty uterus on ultrasound
Management
• Observe closely for continued bleeding or
signs of infection
• Regular diet
• Rest (few days to 2 weeks)
• Tell patient she may experience
intermittent menstrual like flow & cramps
during the following week
• Advise client to return to ER if necessary
4. Incomplete Abortion
• is characterized
by expulsion of
only part of the
products of
conception
(usually the fetus).
Bleeding occurs
with cervical dilation.
Signs and symptoms
- heavy vaginal bleeding
- severe uterine cramping
- open cervix
- passage of tissue
- UTZ shows that some of the products
of conception are still inside the
uterus
Management
• D&C
• Monitor blood loss
• Emotional support
5. Missed Abortion
• is characterized by early
fetal intrauterine death
without expulsion of the
products of conception.
• The cervix is closed,
and the client may report
brown vaginal discharge.
Pregnancy test findings
are negative.
Signs and symptoms
- Absence of FHT
- Signs of pregnancy disappear. Missed
abortion should be suspected when the
* uterus fails to enlarge
* fetal heart sounds are not heard
* a serum or urine test for HCG becomes
(-) earlier than expected or does not
double within 48-72 hours
* UTZ showing no cardiac activity
provides the earliest diagnosis
Management
• UTZ
• If over 14 weeks, labor is induced with
misoprostol (cytotec) followed by oxytocin
augmentation
• D & E or MVA
• If the dead fetus remains too long in the uterus
(after 2 weeks )
DIC (Disseminated intravascular
coagulation) may develop
6. Septic Abortion
• An abortion complicated by infection
Signs & Symptoms:
 Abdominal pain
 Fever
 Vaginal discharge (foul smelling)
Signs & Symptoms:
 Abdominal pain
 Fever
 Vaginal discharge (foul smelling)
 Sick looking, febrile
 Tender uterus
 Cervix – soft & maybe dilated
Management:
• Blood grouping & cross matching
• Antibiotics preferably cephalosporins, if
not available ampicillin and metronidazole.
• Evacuation
• Iron prep. / Blood transfusion if indicated
7. Habitual Abortion / Recurrent
miscarriage
• Abortion occurring in
3 or more successive
pregnancies
Causes:
• Defective spermatozoa or ova
• Deviation of the uterus (septate or
bicornuate uterus)
• Cervical incompetence
Management
• Treat cause
• Specific treatment according to the cause
of abortion
• cervical cerclage-suturing the cervix or
application of cervical cerclage
• fertility drugs-stimulate estrogen &
progesterone production to create a better
nourished uterine lining
Management
• Aspirin or Mini-Heparin – prevents
formation of blood clots that impede blood
flow in the placenta
• Luteal Phase Progesterone Support
• Correction of defects before pregnancy
• Treatment of medical illness
8. Induced abortion
is the intentional termination of a pregnancy
before the fetus can live independently.
Types:
a. Elective - based on a woman's
personal choice
b. Therapeutic-to preserve the health or
save the life of a pregnant woman.
• Medical abortions are brought about by
taking medications that end the
pregnancy. :
Drugs are administered either
orally or by injection.
• The outcome resembles a
natural miscarriage.
• As of 2003, two drugs were available in
the United States to induce abortion:
methotrexate and mifepristone.
• METHOTREXATE. Methotrexate
(Rheumatrex) targets rapidly dividing fetal
cells, thus preventing the fetus from further
developing.
• MISOPROSTOL (CYTOTEC),
a prostaglandin that stimulates
contractions of the uterus.
• MIFEPRISTONE. Mifepristone (RU-486),
which goes by the brand name Mifeprex,
works by blocking the action of
progesterone, a hormone needed for
pregnancy to continue.
Evening primrose oil
this herb can help the
cervix thin and dilate
and prep it for labor.
You can take evening
primrose oil capsules,
or rub the oil onto your
cervix during the last
weeks of pregnancy.
You can even insert the
capsules into your
vagina.
Evening primrose is a
plant native to North
America, but it grows in
Europe and parts of the
Southern hemisphere as
well. It has yellow flowers
that bloom in the
evening. Evening
primrose oil contains the
fatty acid gammalinolenic acid (GLA).
EPO is an oil that comes from the evening primrose
plant. This oil contains linolenic acid, gamma linolenic
acid, and vitamin E.
EPO has been used in therapies for a variety of health
issues, including cancer, neuropathy, premenstrual
syndrome, menopause, and rheumatoid arthritis
Picture of Baby Miscarried at 12 Weeks
Saves Unborn Baby From Abortion